Daniel Jurich1, Sally A Santen, Miguel Paniagua, Amy Fleming, Victoria Harnik, Arnyce Pock, Aubrie Swan-Sein, Michael A Barone, Michelle Daniel. 1. D. Jurich is senior psychometrician, National Board of Medical Examiners, Philadelphia, Pennsylvania. S.A. Santen is senior associate dean of evaluation, assessment and scholarship of learning and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. M. Paniagua is medical advisor, Test Development Services, National Board of Medical Examiners, and adjunct associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. A. Fleming is associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. V. Harnik is associate dean for curriculum and associate professor, Department of Cell Biology, New York University School of Medicine, New York, New York. A. Pock is associate dean for curriculum and associate professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. A. Swan-Sein is director, Center for Education Research and Evaluation, and assistant professor of educational assessment, Columbia University Vagelos College of Physicians and Surgeons, New York, New York. M.A. Barone is vice president of licensure, National Board of Medical Examiners, Philadelphia, Pennsylvania. M. Daniel is assistant dean for curriculum and associate professor, Departments of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119.
Abstract
PURPOSE: To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change. METHOD: Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group. RESULTS: Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships. CONCLUSIONS: Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.
PURPOSE: To investigate the effect of a change in the United States Medical Licensing Examination Step 1 timing on Step 2 Clinical Knowledge (CK) scores, the effect of lag time on Step 2 CK performance, and the relationship of incoming Medical College Admission Test (MCAT) score to Step 2 CK performance pre and post change. METHOD: Four schools that moved Step 1 after core clerkships between academic years 2008-2009 and 2017-2018 were analyzed. Standard t tests were used to examine the change in Step 2 CK scores pre and post change. Tests of differences in proportions were used to evaluate whether Step 2 CK failure rates differed between curricular change groups. Linear regressions were used to examine the relationships between Step 2 CK performance, lag time and incoming MCAT score, and curricular change group. RESULTS: Step 2 CK performance did not change significantly (P = .20). Failure rates remained highly consistent (pre change: 1.83%; post change: 1.79%). The regression indicated that lag time had a significant effect on Step 2 CK performance, with scores declining with increasing lag time, with small but significant interaction effects between MCAT and Step 2 CK scores. Students with lower incoming MCAT scores tended to perform better on Step 2 CK when Step 1 was after clerkships. CONCLUSIONS: Moving Step 1 after core clerkships appears to have had no significant impact on Step 2 CK scores or failure rates, supporting the argument that such a change is noninferior to the traditional model. Students with lower MCAT scores benefit most from the change.
Authors: Monica M Cuddy; Aaron Young; Andrew Gelman; David B Swanson; David A Johnson; Gerard F Dillon; Brian E Clauser Journal: Acad Med Date: 2017-12 Impact factor: 6.893
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